Background Safety and acceptability of sedative selfadministration by patients receiving mechanical ventilation is unknown. Objectives To determine if self-administration of dexmedetomidine by patients is safe and acceptable for selfmanagement of anxiety during ventilatory support. Methods In a pilot trial in 3 intensive care units, 17 intubated patients were randomly assigned to dex medetomidine and 20 to usual care. Dexmede tomidine was administered via standard pumps for patient- controlled analgesia, with a basal infusion (0.1-0.7 μg/kg per hour) titrated by the number of patient-triggered doses (0.25 μg/kg per dose). Safety goals were heart rate greater than 40/min, systolic blood pressure greater than 80 mm Hg, and diastolic blood pressure greater than 50 mm Hg. Acceptability was based on patients' self-reported satisfaction and ability to administer the sedative. A 100-mm visual analog scale was used daily to assess patients' anxiety. Results The sample was 59% male and 89% white. Mean values were age, 50.6 years; score on the Acute Physiology and Chronic Health Evaluation, 60.1; and protocol duration, 3.4 days. Five dexmedetomidine patients had blood pressure and/or heart rate lower than safety parameters, necessitating short-term treatment. Nurses' adherence to reporting of safety parameters was 100%; adherence to the dexmedetomidine titration algorithm was 73%. Overall baseline anxiety score was 38.4 and did not change significantly (βday = 2.1; SE, 2.5; P = .40). Most dexmedetomidine patients (92%) were satisfied or very satisfied with their ability to self-administer medication. Conclusions For select patients, self-administration of dexmedetomidine is safe and acceptable.
Bibliographical noteFunding Information:
FINANCIAL DISCLOSURES This research was supported in part by the National Institute of Nursing Research grant 1R21 NR012795 and by Hospira, Inc. The content is solely the responsibility of the authors and does not represent the official views of the National Institute of Nursing Research, the National Institutes of Health, or Hospira, Inc.